Why Babies Wake at Night

Written by Hilary Nobilo, MMH (Perinatal and Infant), PGDipChAd, PGCComChH

Many parents would argue that the expression “sleeping like a baby” is an anomaly. Parents often share their experiences of disturbed sleep and wonder if they’ll ever have a good night’s sleep again. However, what might be perceived as an infant sleep problem is more often than not, a normal part of infant sleep development. Much of Western culture holds an unrealistic and developmentally inappropriate view that babies should sleep through the night from the first few months yet typical sleep patterns undergo considerable developmental changes over the first three years and parents can expect disruptions and challenges over that time.¹

At birth, newborns are unable to distinguish between day and night. Their sleep-wake rhythms (circadian rhythms) are developing over the next three months. During early development, babies spend more time in Rapid Eye Movement (REM) sleep or active sleep than children and adults and also move through shorter cycles of sleep pattern.² This predominance of active sleep plays an important role in early brain development.³ Most babies need help during these early months to transition through sleep cycles as they have not yet developed the regulatory capacity to fall back to sleep alone.⁴ 

At four months, babies typically wake briefly four to six times during the night.⁵ Although the total number of hours sleep doesn’t change significantly, by four months, most healthy full-term babies spend the majority of their sleep hours during night-time.⁶

Although some have the capacity to settle themselves back to sleep and self-soothe as they transition through sleep cycles, many still need their parents to help them. Initially, sleep patterns are dependent on a baby’s hunger and at four months, some are still needing a night feed. After a soothing bed-time settling, many babies of this age can be left in a drowsy but still awake state to fall asleep on their own. Babies who learn to self-soothe generally find it easier to fall asleep without help when they wake in the night.⁷

Between four and six months, babies are showing more interest in their family and surroundings, so may need a quiet place to settle.⁸ This is an appropriate time for a consistent bed-time routine to be introduced. Although consistency is critical, parents need to adapt sleep routines according to their baby’s changing developmental needs. By now, many babies are developing the regulatory capacity to return to sleep by themselves without help from a parent.⁹ Introducing a soft toy or blanket that the baby can reach for during the night can be helpful.¹⁰

Between six and twelve months, sleep difficulties may increase. Over this time, babies develop an understanding that parents still exist when they can’t be seen.¹¹ This is also the time when babies’ attachment to their primary care-giver (usually the mother) is evident. Babies may expect to be comforted by an attachment figure when they wake and cry in the night. This is a normal and healthy part of development and parents need to reassure their baby that they’re close by. Babies who are comforted by responsive parents are shown to settle more quickly over time.¹² A bed-time routine consisting of three to four calming activities, such as bath, pyjamas and stories can be helpful for older babies.¹³ 

Towards the end of the first year, babies become consumed by the development of new motor skills and their determination to master these skills can upset sleep rhythms.¹⁴ Changes to routines may also unsettle toddlers and result in night waking.

During the second year, young children experience more fears and can become frightened by new or incomprehensible day-time events. This can result in babies becoming increasingly resistant to separation from parents at bed-time.¹⁵They continue to wake briefly four to six times a night as a result of normal sleep rhythm patterns though many parents will be unaware of these wakings if children are able to settle themselves back to sleep.¹⁶ 

Sleep, like all infant development takes place within a context of relationship, genetic and environmental factors. Sleep problems may reflect problems parents are experiencing. Family stress and difficulties in parents’ relationships are factors that are shown to have an influence on babies’ sleep patterns.¹⁷ Disruptions to family life, such as shifting house, bereavement, loss of employment, birth of a new sibling or a trip away can also be unsettling. However, some relationship influences are bi-directional and sleep problems may be contributing to negative family outcomes.¹⁸ Genetic factors come into play with infant temperament and individual differences. Babies who have difficulty adapting to changes and hypersensitive babies who startle easily and react to changes in light, sound or touch, are more likely to experience settling problems.¹⁹ The physical health of a baby can also increase vulnerability. Sleep problems occur more frequently in babies with gastro-oesophageal reflux, ear infections, teething, allergies and milk intolerance.²⁰

Cultural values and beliefs in regard to infant sleep practices influence parents’ expectations and their ways of managing sleep.²¹ A family’s culture will also influence sleeping arrangements. Western culture is one of the few in the world that sees young babies sleeping in rooms alone.²² Parents can become overwhelmed and exhausted by interrupted sleep and support from extended family and friends can be a considerable help through this time. Some families benefit from professional help.

Infancy is a time of significant change and development and this is reflected in the variability of sleep patterns over this time. Sleep problems are a common concern for parents as babies learn to regulate and consolidate their sleep. Understanding that settling difficulties and night-wakings are a normal part of infant development can help parents respond to their baby in a way that meets developmental and emotional needs.

Footnotes

1. Owens & Burnham, 2009
2. Jenni et al., 2004
3. Stickgold, 2005
4. Mares et al., 2011
5. Owens & Burnham, 2009
6. Raju & Radtke, 2012
7. Owens & Burnham, 2009
8. Warren, 2012
9. Mares et al., 2011
10. Gold, 2011
11. Fogel, 2009
12. Australian Association of Infant Mental Health Inc., 2004
13. Owens & Burnham, 2009
14. Brazelton, 1993
15. Owens & Burnham, 2009
16. McNamara et al., 2003
17. Owens & Burnham, 2009
18. Owens & Burnham, 2009
19. Sadeh et al., 1992
20. DeGangi, 2000
21. Tipene- Leach et al., 2000  
22. Sadeh & Anders, 1993

References

Australian Association of Infant Mental Health Inc. (2004). Position Paper 1. Controlled crying. Retrieved from www.aaimhi.org 

Brazelton, T. B. (1993). Touchpoints. The essential reference guide to your child’s emotional and behavioural development. Australia: Doubleday.

DeGangi. (2000). Pediatric disorders of regulation in affect and behaviour. A therapists guide to assessment and treatment. Boston: Academic Press.

Fogel, A. (2009). Infancy: Infant, family and society (5th ed.). NY: Sloan Publishing, LLC.

Gold, C. M. (2011). Keeping your child in mind. Overcoming defiance, tantrums and other everyday problems by seeing the world through your child’s eyes. Philadelphia: Da Capo Press.

Jenni, O. G., Borbely, a. A., & Achermann, P. (2004). Development in the nocturnal sleep electroencephalogram in human infants. American Journal of Physiology: Regulatory, Integrative and Comparative Physiology, 286, R528-R538. 

Mares, S., Newman, L., & Warren, B. (2011). Clinical skills in infant mental health: The first three years (2nd ed.). Camberwell, Victoria: ACER Press.

McNamara, P., Belsky, J., & Fearon, P. (2003). Infant sleep disorders and attachment sleep problems in infants with insecure-resistant versus insecure-avoidant attachments to mother. Sleep and Hypnosis, 5(1), 7-14. 

Owens, J., & Burnham, M. (2009). Sleep disorders. In C. H. Zeanah (Ed.), Handbook of Infant Mental Health (pp. 362-376). New York: Guilford Press.

Raju, D. V., & Radtke, R. A. (2012). Sleep/wake electroencephalography across the life-span. Sleep Medicine Clinic, 7, 13-22. 

Sadeh, A., & Anders, T. F. (1993). Infant sleep problems: Origins, assessment, intervention. Infant Mental Health Journal, 14(1), 17-34. 

Sadeh, A., Lavie, P., & Scher, A. (1992). Temperament and night waking in early childhood, revisited. Sleep Research, 21, 93. 

Stickgold, R. (2005). Sleep-dependent memory consolidation. Nature, 437, 1272-1278. 

Tipene- Leach, D., Abel, S., Park, J., Finau, S., & Lennon, M. (2000). Maori infant care practices: Implications for health messagers, infant care services and SIDs prevention in Maori communities. Pacific Health Dialogue, 7, 29-37. 

Warren, B. (2012). The unsettled infant. In L. Newman & S. Mares (Eds.), Contemporary approaches to infant and child mental health. Victoria: I P Communications.

First published in Brainwave Trust Newsletter 18, Winter 2013